Medical Social Media Factoids….Breaking News

 

Facebook, the “F-Word” for Doctors  Doximity a private MD Social Network. What happened to SERMO?

 

        

Is Facebook Poised to Revolutionize Health Care?

Zuckerberg will appear on Good Morning America, and later on Tuesday, Sandberg will appear on World News With Diane Sawyer. Facebook is declining comment, but almost all observers are expecting them to introduce a tool that will “save lives.” That could be an expanded version of its Lifeline program, which allows people to alert the company when they think a friend is expressing suicidal intentions, a broader rollout of anti-cyberbullying initiatives or perhaps something altogether different.

Facebook announced this week that it plans to include in user profiles their intent to donate  organs after death. I am not quite sure why they would include this as a choice in a profile when it could easily be included electively in anyone’s profile. Perhaps this unique ‘field’ allows them to search for specific health issues.  It will be interesting to see if they include or add other items such as allergies, and other previously confidential issues. It’s one thing having it on your driver’s license or identification card and another to put it on a billboard.  It may also serve to increase donors which at times are relatively scarce.  If users give implicit permisson by posting this information it may become common occurrence.  A precautionary note that some may abuse this and use it as a means to sell body parts.

1-in-20 U.S. Physicians Now On Doctors-Only Social Network

They're not Facebook-like numbers just yet, but after just seven months Doximity has signed up about one out of every 20 U.S. physicians for its LinkedIn-like networking service.

That amounts to more than 30,000 doctors, or twice as  many on LinkedIn. The reason doctors shy away from LinkedIn and other mainstream social networks is, unlike Doximity, there are no privacy protections in place that will keep physicians on the right side of patient privacy laws. Previous attempts at a doctor-only social network required physician anonymity, which made it all but useless when it came to make referrals or conferring on a diagnosis.

"For a lot of these guys, Facebook is the F-Word."

Doximity, the largest professional network for physicians, announced today it has partnered with several expert network firms to power their medical expert searches.

Physician network signs major partners guaranteeing minimum honoraria for members who opt-in to research interviews .

Doximity launched ExpertFinder, a new service the company says will make it easier for doctors to find experts and opt-in to research interviews. The announcement seems to position Doximity as an early leader in the mobile health care device market, which could quadruple to $400 million in annual revenues by 2016.

Now here is the ‘Kicker”

ExpertFinder automatically integrates data from PubMed, Clinicaltrials.gov and other public databases into physicians’ profiles. Doximity members can then fine-tune their profiles to reflect past and current academic positions, publications, lectures, awards, and clinical interests.  All done seamlessly, and transparently.

For a brief video demo of Doximity ExpertFinder 

 

 

iOS Health & Fitness Apps Will Grow to 13K by 2012

The average cost of a health app has risen from $2.77 this February to $3.21 in June, about the same price as a gallon of gasoline in some places. There are also significantly fewer health apps than are listed as such in Apple's Health and Fitness category. Of the 9,000 apps available now, say analysts, many are novelties.

These are items that are billed as being for the health and wellbeing of the sick and suffering but are really no more than gimmicks that play into fears about our health and our bodies.

We reported a few weeks ago about the FTC levying fines against two app makers that claimed users could erase their acne using colored lights from the iPHone.

 

Technorati Tags: Sermo,Facebook,Doximity,Social Media,acne,iOS,health,fitness,mobile apps,mhealth,expert finder,iPhone,ftc fines

Health Care Social Media Channels

 

Social Media for Young People

ePatients are savy about social media

Part I

Part II

Part III

Best Practices in Social Media

 

Technorati Tags: hcsm,social media channels,youtubehealth

What’s Your Poison ?

 

As we talk more an more about ‘Patient Centric” healthcare, surveys reveal patient and consumer opinions on health reform and resources.

Krames Staywell (A research survey company) has tabulated their interests and the means for which they use different forms of communications. Not surprisingly the differences are clearly age-related.  It also differs for office, insurance, hospital, and health information. Social media communication is on the rise as well.

HOW THE STUDY WAS CONDUCTED

• quantitative online survey of consumers 21 years of age or older who are responsible for health care decisions for their households
  •     conducted by a full-service market research firm focused solely in the health care environment
  •     interviewing conducted October 21–November 1, 2011
  •     400 interviews completed with a sample error of +/- 4% at the 90% confidence level

 

The study covered consumer opinions and attitudes on a wide range of health care issues:
•     Level of concern about health care
•     Factors that influence provider selection
•     Interest in electronic medical record
•     New media habits –        awareness and use of mobile technologies
•     Paying for care
•     Importance of quality information
•     Advertising formats and themes with impact

When seeking for information outside the doctor’s office, people use a mix of old school and new school  sources for answers to their health questions.
Where do consumers turn first for health care information? 

The question:

“Besides your physician, from which of the following have you sought health-related information from in the past year?  In rank order from the most frequently consulted to the least:

Consumer health website
Google
Friend/Family
Books, magazines, newspapers
Health plan website
Called health plan directly
Health plan newsletter
Hospital newsletter
Newsletter at doctor’s office
TV or radio programs
Hospital website
Called hospital directly
Online support group
A health resources center or library
Consumer Reports
You Tube
CMS Hospital Compare website
Blog or microblog
Mayo Clinic website
Centers for Disease Control
Social media
HealthGrades website
National Institutes of Health
Independent hospital or physician quality ratings organization
Podcast or Webcast

Media for Health Education

The Most Prevalent Queries relating to health care are:

In Rank Order from most common to least common

Articles on health and wellness
Preventive health information
Answers related to a specific health concern for you/family/friend
Lifestyle advice for everyday use
Health care reform and how it will impact you and family
Clinical information about specific health conditions
Health care articles and information personalized to your own health status
Health care articles and information personalized to the health status of someone you care for
How to prepare for Medicare
Support and advice for managing health-related costs
Accountable Care Organizations
Have not read about any of these topics

Further specific details are available as a download from Krames Staywell

 

Technorati Tags: medical home,patient centric,online,patient portals,health web health care information,webmd,patientslikeme,mayoclinic,nih,healthgrades,fda

SCOTUS Decision will be Critical to Economy

 

Either way the decision goes enormous changes will occur in the U.S. economy. As the Patient Care and Affordability Act plays out reality is effecting hospitals, doctors, insurers, Medicare and Medicaid.  This does not even factor the secondary consequences upon employers, large and small.

Several major goals of “Obama Care” have been initiated:

1. The implementation of “no prior illness can be reason for denying coverage

2. Minors will be eligible for insurance in their family’s insurance policy until the age of 25.

Looming on the horizon in August 2012 (three months from now) is the ruling that insurance companies must limit their administrative costs to a specified amount. Many companies thus far have failed to accomplish this, and face a  $ 1.5 billion dollar rebate in August

According to the Kaiser Family Foundation:

:Marylanders will receive $37.7 million from four insurance providers, according to the report. Kaiser did not name the insurers, but said the average rebate for Marylanders will be $293.50..”

The rebates will be paid by August of this year by insurers who are not following the provision that says insurers offering coverage to individuals and small businesses must devote at least 80 percent of their premium income on health care claims and "quality improvement" activities. Large group plans must spend at least 85 percent.

The rule went into effect in 2011 and this will be the first year rebates are paid. Full implementation of health care reform is slated for 2014. But their is uncertainty as the U.S. Supreme Court debates key parts of the law.

American Health Insurance Plans criticized the provision in the following statement:

“The new medical loss ratio requirement (MLR) does nothing to address the real driver of premium increases: the underlying cost of medical care.  Given the inherently unpredictable nature of health care costs, it is not surprising that some health plans expect to pay rebates to consumers in certain markets. However, the coverage disruptions and other unintended consequences of imposing a new arbitrary federal cap on health plan administrative costs are likely to outweigh any benefit these rebates will provide to consumers.  Moreover, the taxes, benefit mandates, and other regulations included in the health care reform law will cause premium increases that far exceed the value of prospective rebates.  For example, a technical analysis by Oliver Wyman estimates that the new health insurance tax included in the ACA “will increase premiums in the insured market on average by 1.9 percent to 2.3 percent in 2014,” and by 2023 “will increase premiums 2.8 percent to 3.7 percent.”

One thing is certain, we need to turn down the rhetoric.  The issues go far beyond partisan politics. Either issue…the Economy  and/or Health Reform are symbiotic and dependent upon each other. Politicians are failing to address this connection to their constituents, and so are health care experts.

A recent survey by Krames Staywell shows the economy is of concern to 42% of those polled, and to health 27% see it as a primary concern.

Health care reform advocacy group Health Care for America Now said the rebates are a victory for consumers.

"For far too long, health insurance companies have been ripping off consumers, and Obama care finally put a stop to that," the group said in a statement. "The rebate money will come to consumers from insurance companies that spent too little on medical care and too much on profit, red tape and bloated CEO pay."

What’s your opinion?  Repeal Obama care completely?  Have SCOTUS remand the law to Congress with Constitutional Guidelines? Just throw out the Individual Mandates?

What should be done with the changes already enacted?

In the next several weeks take a look at Health Train Express’ new presence at Google Plus and here at G + MD

 

Technorati Tags: Obamacare,scotus,health care for america now,ahip,kaiser family foundation

Keep Your Head Down, Shut Up and Forge Ahead

 

A blog colleague of mine who writes “Dr J’s House Calls” who I am certain would not mind my telling you her non-stage name is Mary Johnson M.D. while I explain her life since medical school.  While this is not the worst case scenario I have stumbled upon, it is a heart-breaking story of how things do not always turn out for the best.

I won’t go into a lot of detail here, for the story is told nobly if a bit one sided I do not doubt for a minute what she tells is the absolute truth about Randolph Hospital

There’s something about ‘Mary” as the movie title says.  Mary has INTEGRITY and she stands by her story, never  blinking, nor questioning her role in playing into the hands of dirty politics, good old boy networking and the power of money.

If you are a young physician or medical student thinking of taking on scholarships/loans to be forgiven for time spent in National Health Service, according to Mary Johnson consider the alternatives. Military Service, Loans not based upon indentured servitude, and perhaps even not going into a medical career at all.

I have been reading her “stuff” since 2005  when we were both much younger.

Her stories are as fresh today as they were when she wrote them in 2005. At first I determined it was all “cut and paste”. then decided she needed to be medicated for a fixation, or obsessive compulsive disorder.  I am sure many thought the same.

However I am not dismissive of anyone in so much pain. I also thought she enjoyed the pain and playing the role of ‘victim’. It played out in a sado-masochistic sort of way.  But I was wrong once again. 

Mary simply broadcasts a warning to all young, altruistic, inexperienced physicians being led to slaughter (and not even getting the bar of soap (stone) by hospitals, other physicians (who should know better, or who sold out a long time ago) and now it will be Obama Care.

That brings us up to today and her latest post of Dr. J’s House Calls.

Admittedly it is a long read, but it can be summarized quickly reading her first post and this most recent one.   I sum it up….”There’s Something About Mary”

After reading about  Dr. J’s tribulations I now understand much more about John Edwards.

Mike Wallace may be turning over in his grave.

And as for Mary Johnson…..I still love you.

 

Technorati Tags: Mike Wallace,Dr J's Housecalls,Randolph Hospital,Mary Johnson MD

Digital Health Space MyVeHU and G + MD

 

Digital Health Space is a new Google Plus Page. It features breaking medical news, social media information for health professionals. It also provides links to medical meetings, social media users in health and related information.

This week Digital Health Space introduces MyVeHU Campus. MyVeHU Campus provides an online tutorial and reference for learning about Electronic Medical Record Systems.

Watch for G + MD Hangouts where interviews and broadcasts will be hosted and streamed “On Air” via YouTube “live”. Circle G + MD to receive the schedule and Scheduled Guests.

Content of G + MD will be moderated.

Health Care Social Media #hcsm  are encouraged to apply and participate as “EXPERTS” in their field. Categories may include but are not limited to: Health Care and Social Media , My Favorite Social Media Platform(s), Why and How I use Social Media, The Future of Social Media in Health Care, What's New in Social Media This Week? Primary Care, What's in it For Me? Opinions on Health Reform, Do You Know what Health 2.0 is? Can You Market your Medical Business using Social Media?

Additional Topics: To Be Announced.

I hope you will participate. Bring me your ideas.

Gary Levin MD

 

Technorati Tags: MyVeHU,G+MD,Digital health space,hcsm,on air hangout,health care social media,YouTube Live

Down the Rabbit Hole “Alice in Wonderland”

 

 

Most physicians when questioned about PPACA are truly ambivalent about the law and whether the fact that it may very well  be unconstitutional.

However they do not want reform to fail completely, nor undo more than two years of preparation, not only through publicly funded efforts, but the private hospital preparations and hard cold assets poured into HIT, health reform, ACOs and other organizational imperatives.

In fact if PPACA is overturned or throttled by the constitutional issues much of the changes will not be wasted at all. Some experts state they fail to see ROIs for HIT and other reform proposition.  However as Yogi Berra once said, “It ain’t over until its’ over”.  The time elapsed is still very short when compared to the life of Medicare and medical practice in America.

The Supreme Court is at a difficult juncture.  Their decision will ultimately effect our health non-system in whichever direction they decide.

One of the few groups willing to address the subject was the American Medical Association. In a statement, the AMA's president-elect, Jeremy Lazarus, says, "With the countless hours of work already done to implement this new law, it is hard to imagine the full impact of it disappearing."

Reading the Federal Register on health care issues is a daunting task, as are the determinations set for in the regulations.

It will require some serious “reverse engineering”  in any case no matter what SCOTUS decides to ‘throw out’

"I think it's more akin to Alice in Wonderland," it has been said. "That we're going down the rabbit hole and nobody really knows what it's going to look like inside."

But in the next few months, they may find out.

Here are some who offer their “wisdom”

Some might opine, “It’s as good as any”

Rabbit
Oh my ears and whiskers, how late it's getting!

Alice's Adventures in Wonderland:
Either the well was very deep, or she fell very slowly, for she had plenty of time as she went down to look about her and to wonder what was going to happen next.

Lewis Carroll Quotes
If you don't know where you are going, any road will take you there.

Alice's Adventures in Wonderland:

Alice: But it's no use going back to yesterday, because I was a different person then.

Through the Looking Glass:

The Queen: Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!

 

Technorati Tags: affordable care act,scotus,hit,health reform,aco,ppaca,medicare,alice in wonderland,lewis carroll,american medical association

Primary Care and How it can Cut the Cost of Renal Failure

 

Telemedicine Can Cut Health Care Costs by 90%

by Vijay Govindarajan

Vijay Govindarajan is the Earl C. Daum 1924 Professor of International Business at the Tuck School of Business at Dartmouth. He is coauthor of Reverse Innovation (HBR Press, April 2012).

The title for the post is a bold one. It is a vague, sweeping declaration, certainly one we would all like to believe, an it grabs one’s attention to see how the conclusion has been derived by Dr Govindarajan.

If you've not yet heard of telemedicine or think that it's not a great  way to deliver quality health care, you may want to read this. Telemedicine, made possible by the availability of mobile networks, is revolutionizing health care. But not in the U.S.

You have to look to India, where telemedicine is already widely used in the delivery of health care — and is saving lives even in the most rural corners of the country. Nephrologists have developed a system that allows for peritoneal dialysis at home in  lieu of the more expensive hemodialysis with expensive devices in dialysis centers or in hospital. At home PD requires no vascular access ports, pumps or technical personnel. It can be accomplished by a trained patient with minimal if any supervision.

Dialysis Center                          At Home Peritoneal Dialysis

The major barrier in the acceptance of PD is concern that patients won't have proper access to a doctor — especially in geographically dispersed countries such as the United States. As a result, less than one in twelve ESRD patients are treated with PD. The net result? It costs over $170,000 to treat patients with ESRD in the U.S., using the more expensive HD.  HD requires a network of redundant hemodialysis centers scattered within travelling distance for a procedure necessary several times a week.

It doesn't have to be this way. The "distance" between the patient and the PD unit can be overcome, at a dramatically low cost, by efficient use of the internet, mobile phones, and a strong home visit protocol. To quote Dr. Nayak: "Our success can easily be replicated in the U.S. Conservatively, even if 15% of ESRD patients choose PD over HD, cost savings for Medicare and Medicaid will run into many millions of dollars every year."

After signing into the (secure) hospital website, patients and caregivers are directed to a personalized home page from which they can use the site to enter and share information. Health complaints made by patients receive immediate response. Remote monitoring is augmented by a home visit protocol that ensures that each PD patient's progress is followed up by a well-trained clinical coordinator (CC) on a regular basis. The CCs are trained to follow a set protocol and are equipped with a standardized checklist for a step-by-step assessment of patient well-being during each visit. All this information, together with a brief summary of the patient's most current laboratory results, is conveyed to the nephrologist by SMS from the patient's home. The CC is instructed to wait until the nephrologist responds (usually within 15 minutes), and then to counsel the patient accordingly. CCs also assess and advise patients on nutrition, psycho-social well-being, and physical fitness and rehabilitation levels.

Dr. K. S. Nayak, Chief Nephrologist at the Lazarus Hospital in Hyderabad, India, and his team are able to treat ESRD patients using PD, supported by  mobile phone short messaging service (SMS), inexpensive digital cameras, and the internet to address patient accessibility issues.

The hospital retrospectively analyzed 115 rural patients who had started PD using this remote monitoring technology. Amazingly, rural patients performed well on PD and had significantly better survival rates than did their urban counterparts.

What is the primary driver of this system-wide inefficiency and cost? Most health care providers would agree that it is physician "mindset:" higher physician reimbursement for HD than PD, and concerns about accessibility in a geographically vast country contribute to historically low use of PD in the U.S.

Author comments:  Gary M. Levin MD

In this now Patient-Centric health model in the U.S. a driving force for P.D. should be patient demands for quality of life issues and cost.

Primary care physicians should encourage nephrologists to make peritoneal dialysis a predominant form of dialysis if indicated.  In the coming changes in reimbursement not based on procedures, this may become a reality.  Most patients on ESRD (end stage renal disease) programs are already funded by a separate Medicare administrative system. Prior authorization for HD may become a routine to select HD in lieu of HD.

The "distance" between the patient and the PD unit can be overcome, at a dramatically low cost, by efficient use of the internet, mobile phones, and a strong home visit protocol.

To quote Dr. Nayak: "Our success can easily be replicated in the U.S.

Ref:  Health 2.0 News

 

Technorati Tags: dialysis,hemodialysis,peritoneal dialysis,telemedicine,reimbursements,primary care,nephrologist,dialysis center,Vijay Govindarajan center,esrd,medicare,medicaid,india dialysis

Brave New World

 

Author: G. M. Levin M.D., Attribution to the American Medical Association, AMED news

 

More details are forthcoming regarding ACO establishment and leadership. One of the key announcements is that 27 of the leaders of ACOs will be physician leaders. AMA Medical News announced that “Thousands of physicians will be among those coordinating patient care in the 27 accountable care organizations that were chosen in April to participate in the new Medicare shared savings payment model.”

Organized medicine was pleased to see that 21 of the 27 ACOs would be physician-run. The American Medical Association also noted that five of the approved groups will participate under an advance payment model, which provides up-front funding from Medicare to cover the costs of establishing the infrastructure needed to coordinate patient care. Advance payments make it possible for smaller groups of doctors to participate in the program in a leadership role, said AMA President Peter W. Carmel, MD. More than 50 organizations have applied for the advance payment option beginning July 1.

So far, CMS has received more than 150 applications seeking approval to participate in the second phase of the program, and the agency will announce the groups that qualify in July. Another round of applicants will be approved in January 2013.

The newest organizations to be chosen, which involve more than 10,000 physicians, have agreed to coordinate care for nearly 375,000 Medicare beneficiaries, the agency said during an April 10 briefing with reporters.

Safeguards are being put in place to insure equality with physician leadership and control

Plymouth Bay Medical Associates, Jordan Physician Associates and a number of specialty physicians from Jordan Hospital joined to form Jordan Community ACO in Plymouth, Mass. Physicians in the network will coordinate care for more than 6,000 Medicare patients.

The Vitruvian Man,  Leonardo Davinci, circa 1478 (Wikipedia)

The ACO is structured so that physicians and the hospital have an equal say in how the organization will operate and share in any savings. The pool of doctors, who mostly are primary care physicians, and the hospital each have one vote, and a majority is needed to move forward. That effectively means decisions must be unanimous or both sides continue negotiating.

This is unchartered ground so far, and the ACO will be looking for Medicare patients to be active rather than passive participants in the care model. “Patient education is paramount for any project to work,” Dr. Johnson said.

Accountable care organizations that provide higher-quality care and cut costs can earn bonuses from Medicare. Groups will be evaluated by their performance on 33 quality measures, their use of preventive health services and whether they improve care for at-risk patients. The 27 ACOs participating in the systemwide shared savings program as of April 1 will be joined by additional members in July.

But beneficiaries still retain the right to choose physicians outside an ACO.

 

Physician-led ACOs

• Accountable Care Coalition of Caldwell County, Lenoir, N.C.
• Accountable Care Coalition of Coastal Georgia, Ormond, Fla.
• Accountable Care Coalition of Eastern North Carolina, New Bern, N.C.
• Accountable Care Coalition of Greater Athens, Ga.
• Accountable Care Coalition of Mount Kisco, N.Y.
• Accountable Care Coalition of the Mississippi Gulf Coast, Clearwater, Fla.
• Accountable Care Coalition of the North Country, Canton, N.Y.
• Accountable Care Coalition of Southeast Wisconsin, Milwaukee.
• Accountable Care Coalition of Texas, Houston
• AppleCare Medical ACO, Buena Park, Calif.
• Chinese Community Accountable Care Organization, New York.
• Coastal Carolina Quality Care, New Bern, N.C.*
• Crystal Run Healthcare, Middletown, N.Y.
• Florida Physicians Trust, Winter Park, Fla.
• Jackson Purchase Medical Associates, Paducah, Ky.*
• Optimus Healthcare Partners, Summit, N.J.
• Physicians of Cape Cod ACO, Hyannis, Mass.
• Premier ACO Physician Network, Lakewood, Calif.
• Primary Partners, Clermont, Fla.*
• RGV ACO Health Providers, Donna, Texas*
• West Florida ACO, Trinity, Fla.

Nonphysician-led ACOs

• AHS ACO, Morristown, N.J.
• Arizona Connected Care, Tucson, Ariz.
• CIPA Western New York IPA, doing business as Catholic Medical Partners, Buffalo, N.Y.
• Hackensack Physician-Hospital Alliance ACO, Hackensack, N.J.
• Jordan Community ACO, Plymouth, Mass.
• North Country ACO, Littleton, N.H.*

 

*  These ACOs are receiving advance Medicare implementation funding.

Source: “First Accountable Care Organizations under the Medicare Shared Savings Program,” Centers for Medicare & Medicaid Services, April (cms.gov/apps/media/press/factsheet.asp)

TEDMED Social Media in Vivo

 

I admit it. T.E.D. 2012 from San Francisco CA was lost in the clutter on my radar screen this month by tax day and a myriad number of social media projects I am involved in. As an inadequate apology here is  TEDMEDs 2012 PROGRAM . TEDMED is well established as an annual affair and is well accepted as a source of information for the present and future. The speakers cross a wide divide of topics from social concerns to science and at times science fiction. Well respected, this year the TEDMED was carried by simulcast live at UCSF.  For the rest of us we will have to wait for the archived event to be published.\

“TEDMED is the only place where a Nobel Prize-winning neurobiologist has a conversation with a four-star general…where an opera singer (with a double lung transplant) chats with a NASA space physician…and where a ballet dancer talks to an exoskeleton designer,” according to the TEDMED website.

The Program Brochure adequately describes the events:

 

In the interest of not missing the event for 2013, please reserve April 16-19 2013 at The Kennedy Center in Washington, D.C. Apply To Attend  early. It usually sells out.

Speakers have not yet been formally announced, however 2012 Speakers will give you an idea of the energy, excitement and creativity at the TEDMEDs

Sherwin Nuland at TEDMED 2010

Distance between Physician and Patient Increase

As my title for today’s post indicates, TEDMED is THE Social Media Event, Live each year.

Technorati Tags: TEDMED 2012,TEDMED2013,TEDMED program,Sherwin Nuland,UCSF

When Doctors are called Providers

by Shara Yurkiewicz | in Physician

KevinMD featured this touching real story about physicians as caregivers and not providers.  A physician cannot provide health….he can direct traffic and guide patients to return to wellness or accommodate illnesses that cannot be cured or treated.

Here is the story,

“Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street.  I looked for a store, any store, and ducked inside.  The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away.  A store clerk walked over and asked if I was okay.  I knew I’d have to meet her eyes, unable to hide the tell-tale redness and puffiness of my own.  I asked if they had a bathroom I could use.

Being Manhattan, there was no customer bathroom, but the store clerk very gently led me to the staff bathroom and told me to take the time I needed.  After five minutes of some fairly heavy crying, I spent the next ten desperately trying to disguise what I had just done.  I scrubbed my face until it hurt and molded my expression back into that of stoic, aloof New Yorker.  My insides didn’t feel much better, but at least my outsides didn’t betray that anymore.   I emerged, thanked the clerk, and took comfort in the fact that I’d never see her again.

My little episode had only intensified the all-consuming ringing in my ears.  The tinnitus had started two years ago, suddenly and unrelentingly.  Five doctors and five clean bills of health later, I was left with the unchanging advice: “We’ve ruled out anything organic and tinnitus isn’t dangerous, so you’ll just have to get used to it.”  No follow-up appointment necessary.

I was left to my own devices–which included the Internet, snake oil supplements, and my own obsessive mind–and I wasn’t using them well.  Besides being sleepless, irritable, and depressed, the far more damning thing was that I was without any hope.  I couldn’t imagine being able to live happily in my body.

Thinking back, I still can’t figure out why it didn’t dawn on me to consider a psychiatrist instead of an ENT or a neurologist.  The idea to see him wasn’t even my own.

After getting to know me, the psychiatrist eventually suggested medications.  I wasn’t afraid of the side effects, and I began immediately.

A year and a half later, everything is much better, objectively and subjectively.  Though not gone, the auditory disturbances are manageable to the point where they hardly register emotionally.  I don’t much like talking about it, for reasons better articulated by Russell Crowe’s character in A Beautiful Mind:  ”I still see things that are not here. I just choose not to acknowledge them. Like a diet of the mind, I just choose not to indulge certain appetites.”

Of course, most times I go to the doctor, for any purpose, I am asked about the reasons I am on certain medications.  Usually my answer is acknowledged, and the appropriate empathetic response is conveyed.

Recently, I was surprised by one doctor’s version of empathy: “Oh, yes, tinnitus can make you literally want to drive off a bridge.”

Of course, this doctor doesn’t know that 18 months ago, I broke down in midtown Manhattan and wondered how I could live out the rest of my life at this rate.  She assumes by my demeanor that I am well-adjusted and perhaps always have been.  She doesn’t know that sometimes when I listen with my stethoscope for a patient’s heartbeat and I hear ringing, that familiar fear makes my own chest tighten.  Or that sometimes I “indulge” in anxiousness when a tinnitus spike occurs that I cannot ignore.  Or that the very condition she was treating me for was creating such a spike at that moment.

Regardless, I was in “no acute distress,” as the medical lingo goes.  I let it go.

I wasn’t even angry with her off-the-cuff remark.  I say silly things to patients on a weekly basis, and the only reason it isn’t more frequently is that I only see patients once a week.

What reminded me of her remark was a piece by Dr. Danielle Ofri in the New York Times, which was inspired by a New England Journal of Medicine article by Dr. Jerome Groopman and Dr. Pamela Hartzband.

All three doctors rail against the term “provider” instead of “doctor” for a number of reasons: the generic term connotes sterility, commodification, distance, and interchangeability.  ”The words we use to explain our roles are powerful,” Groopman and Hartzband explain.  ”They set expectations and shape behavior.”

This is all fair.  And, as a medical student, I should be in especially staunch agreement.  But I’m not. As a patient, I’ve seen far more “providers” than “doctors.”

I went to the doctor who made the unfortunate comment about my tinnitus because I had an unrelated problem.  She took me seriously, she diagnosed me correctly, she prescribed the appropriate medications, and I got better.  Technically, flawless.  She provided excellent care.

But, Groopman and Hertzband write when we use a term like “provider,” it ignores “the essential psychological, spiritual, and humanistic dimensions of the relationship.”

From a patient’s point of view, though, all it takes it one insensitive comment from the physician to lose that humanistic dimension.  When my doctor made that remark, I relegated her to the impersonal role of provider, someone incapable of understanding my experience but capable of treating my physical problem.  I just wanted to get better.  As Dr. Ofri writes, “It makes [physicians] feel like a vending machine pushing out hermetically sealed bags of ‘health care’ after the ‘consumer’s’ dollar bill is slurped eerily in.”  That is exactly how I saw my doctor.

Was I happy with the care I got?  Sure.  If I have another problem, will I see her again?  Probably.  Was I bothered by her remark?  A little.  Did I care?  Not really.  I didn’t care because I depersonalized her immediately after.  If I cared, the remark would hurt.  I don’t want to hurt.  Is that fair to the doctor?  Maybe not, but I care more about me.

This example is far from unique, for me and for others as well.  There are many reasons people dislike doctors, and many of these reasons are not particularly fair.  But when the same complaints are heard over and over again (“He doesn’t listen to me!”  ”I can’t believe she said that!”  ”He doesn’t understand!”), one has to wonder which came first–the term “provider” or the doctor acting like one.

I’m not dismissing the argument that “provider” is irksome or suggesting that we shouldn’t spend space discussing its consequences.  But I wanted to spend some space on rationalizing why patients may already think in these terms: on how in many cases physical provision of health care is exactly what doctors do, and on how depersonalizing doctors can actually protect patients when their emotional or humanistic care is lacking.  And the term “provider” sometimes fits, even if doctors don’t want to wear it.

“But words do influence us,” Dr. Ofri writes about what doctors are called.  Yes, they do.  Now let’s take those thoughts and apply them to what doctors say too.”

 

Technorati Tags: physicians,providers,primary care

Social Media and the Pot of Boiling Water

Social media, and blogging are a collective affair. Interesting and creative posts and ideas seem to take on a life of their own. It reminds me of the molecules in a pot of boiling water.  The water molecules vibrate faster and faster bouncing off one another until it reaches  100 degrees C.   Adding further energy (heat) creates a change in physical state absorbing more energy and if contained in a space pressure rises or escapes if it is an open vessel.

Social media is a bit like this analogy.The subject starts off slowly and if worthwhile others repost or write a similar blog.  At some point the post takes on a mind of it’s own, travelling through feeds, and aggregation sites.

It’s like that here at the Health Train Express where I want to thank Health Works Collective for it’s continuing and generous redistribution of my meager thoughts and ideas. Much of Health Train’s success is attributable to Joan Justice and her fine team.   Thank you.

 

Technorati Tags: health works collective,social media,blogging